This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Sunday, 27 December 2009

Who wants nurses away from bedside care?

Anytime there is a piece about nursing or care in our hospitals on the net there is always some shmuck posting his thoughts about what the problem is.

"Nurses don't want to work at the bedside"

"Nurses want assistants to do all the real work"

"Nurses want degrees so they can be paid more and not get their hands dirty"

People who say these things are Shmucks.

I even had one jerk telling me that the nurses themselves were behind the hospitals drive to hire care assistants instead of nurses because "nurses don't want to get their hands dirty". Ha ha ha. As if nurses could dictate to the hospital who they hire.

Nurses were forced away from the bedside. They did not leave the bedside because they hate patient care.
I wrote another letter to a manager. I tried to explain that we have more patients than we can handle etc etc etc. That more care assistants than nurses on the team means death and is not at all cost effective.

I actually got a response. But all it does is show that he doesn't have a clue. Nor did he really read my letter.

"Nurses can either take a three year diploma or a four year degree course although there are moves to make all nurses take a degree, and I imagine part of the push behind that is to increase the starting salary. It will also probably mean more assistants on the ward, as the move to make nursing into a more clinical role will mean that the more hands on tasks will devolve to HCAs. This is a shift that has been happening for many years (alongside moving tasks from doctors to nurses) as it reduces costs at the same time as encouraging specialisation."

Fuckhead thinks that "dumbing down" reduces costs! It doesn't. He wants me to "specialise" and play doctor while the HCA's screw up my patients' nursing care. As a matter of fact I am sick and tired of having to play doctor and order diagnostic tests etc because it is taking us 10 hours to get a doctor to see our patients in hospital because there are so few doctors. Example: If the nurses do not order the INR tests for warfarin control then they won't get done for a week.

I have never seen anyone miss a point so massively.

It was NOT the nurses who did this people. It's not about the nurses "not wanting to get their hands dirty".

Edit 28/12.
Clueless management types have destroyed the level of care in our hospitals and driven nurses away. I agree with the commentator who said that nurses need to be indpendent contractors...was it Suzanne Gordon who first said this?. Nurses should be independent contractors and move away from this government run crap. It's worse than corporate run crap really. Let's not be their scapegoats any longer. Let's no longer allow ourselves to be put in situations where we cannot do our jobs.

lucky old Mr Gray it sounds like he now lives a sort of "my family and other animals" kind of life. I wonder how he is going to prevent himself ending up on a medical ward? does he have an advanced directive? does he have "not for medical wards" tattooed on his chest? I hope he has had a swine flu jab. most of our patients have been young and very poorly. maybe that is why militant medical nurse has not been blogging recently? she has swine flu? or is she just burnt out? of is she potty training her puppy or has she emigrated?

I wish you were old enough to remember the days when Matron was in charge of the nursing staff, doctors arrived within minutes of being called (and knew their patients), there was a (working) sister in charge of each ward and the only staff without any nursing training were orderlies and ward maids, and the bureacrats stuck to the non medical side of running a large organisation. The only targets were set by Matron :)

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In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.